Pre-procedure Hypertension

[manowar rules]

Our patient population is prone to hypertension (elderly, in pain, often co-morbidities). But when patients show up for an in-office procedure, at what blood pressure are you guys telling patients “that’s too high, we have to defer your ESI/RFA/etc?”

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[SSdoc33]

Our patient population is prone to hypertension (elderly, in pain, often co-morbidities). But when patients show up for an in-office procedure, at what blood pressure are you guys telling patients “that’s too high, we have to defer your ESI/RFA/etc?”

keep taking the BP until you get a number you feel comfortable with

 

[deleted131481]

Systolic 200 and diastolic 110. There is very weak evidence in the anesthesia literature for worse outcomes for diastolic over 110. Systolic 200 arbitrary but the staff gets nervous. The recorded BP is almost definitely higher than normal due to white coat HTN.

In the same vein, are you all checking POC glucose if diabetic? I'll cancel for glucose > 200-250.

 

[RoloTomassi]

I was just reviewing a med mal case where part of the lawsuit claims that performing the procedure was against standard of care since systolic was over 180, which is hypertensive crisis.

 

[Ferrismonk]

No number cutoff, but I will do the procedure if there are no acute symptoms such as scotoma, dizziness, lightheadedness, etc. and the patient is in severe pain. I emphasize follow up with PCP and danger of CVA, MI, etc.

 

[Laryngospasm]

Diastolic over 110, systolic 200 or any symptoms even if less than that.

 

[manowar rules]

I have been using the same numbers as y’all (ie 200/110 assuming no hypertensive symptoms). I saw a case however where a pain doc was cited for proceeding with an RFA in a hypertensive patient who ended up having a fatal MI during the procedure. The pre-procedure BP was only 150s/90s, but the medical board said that the patient “should have been treated with anti-hypertensives prior to the procedure.” That seems like kind of a stretch to me, I don’t think many of us are breaking out the labetalol in the procedure room.

 

[Laryngospasm]

I have been using the same numbers as y’all (ie 200/110 assuming no hypertensive symptoms). I saw a case however where a pain doc was cited for proceeding with an RFA in a hypertensive patient who ended up having a fatal MI during the procedure. The pre-procedure BP was only 150s/90s, but the medical board said that the patient “should have been treated with anti-hypertensives prior to the procedure.” That seems like kind of a stretch to me, I don’t think many of us are breaking out the labetalol in the procedure room.

Typical medical board high horse bs, so we are supposed to assume anyone with non ideal bp (99% of our patients) needs to be treated prior to any procedure. Standard do as I say not as I do crap. I’ve had way more patients Brady down and pass out than have MIs due to slightly elevated bp.

 

[lobelsteve]

I am chicken, my cutoff is 190/100.

 

[Taus]

I’d suggest 180/110, the definition of hypertensive urgency.

 

[Barleycorn]

I am chicken, my cutoff is 190/100.

Do you attempt to treat them with an antihypertensive and then cancel them if it doesn't come down or do you just cancel them?

 

[Laryngospasm]

I typically cancel and call in some Ativan

 

[BobBarker]

I don’t think we would probably ever know what the BP was in the office as it isn’t being taken.

 

[RoloTomassi]

I think giving antihypertensive opens up a whole can of worms. If BP over the cutoff, and seems partially anxiety driven, and they have a ride, I give PO Versed. If they have known uncontrolled HTN, I have them see PCP/cards to control before rescheduling.

 

[lobelsteve]

Do you attempt to treat them with an antihypertensive and then cancel them if it doesn't come down or do you just cancel them?

In office: cx and pcp or uc if sx present. My office is multispecialty group.

 

[Ducttape]

recheck other arm. make sure to use the proper size cuff.

do not use a machine, have nurse use a manual cuff. machines do not give actual blood pressure per se.

finally, give it 5 minutes. if still 180/100 or greater, i cancel.

any symptoms of hypertensive crisis is recommended going to ER.

better to get BP stabilized as outpatient (ie cancel) than throw a BP med at the patient that will most likely not be continued after procedure. also, steroids transiently increase BP.

 

[Orin]

Depends on a lot of factors. Chronic hypertension in that 180/100 ranges slides by. Asymptomatic or anxiety related can slide by. Any signs of emergency, headaches, abdominal pain, etc do not.

Most often I see patients that skipped their antihypertensive the morning of the procedure and those I'll give a pass to.

200/100+ will need to twist my arm to do